Association Between Frailty Scoring and Cardiopulmonary Exercise Testing. A Retrospective Cohort Study

Introduction Cardiopulmonary exercise testing (CPET), is the gold standard assessment of functional capacity and predicts postoperative outcomes in major abdominal and thoracic surgery, as well as in older individuals undergoing elective surgery for colorectal cancer. However, CPET is resource intensive and not universally available. Simpler objective assessments of functional capacity, such as clinical frailty scale (CFS) scoring, predict post operative complications and may be useful to aid shared decision and perioperative planning. Objectives To assess local cohort data and investigate the association between clinical frailty scoring, CPET outcomes and length of hospital stay. Methods A retrospective cohort analysis of all patients that received a cardiopulmonary exercise test as part of their pre-operative assessment for major abdominal and thoracic surgery between May 2018-December 2022 from four district general hospitals. Results 174 patients, age 73 (mean) CFS 3 (mean), underwent CPET testing with associated CFS scoring. CFS scores were weakly correlated with anaerobic threshold, VO2 peak and ventilatory equivalents, -0.34,-0.36 and 0.31 (all p<0.001) respectively. Linear regression demonstrated a negative coefficient for association of CFS with VO2 peak and AT, -1.22 and -1.70 respectively, both p<0.001. CFS score was not predictive of 1 year mortality in this group. In a subgroup analysis (n=59) there was no association with CFS score and length of stay. Conclusions Our data suggests a weak signal between CFS score and CPET results. Further investigation with larger datasets is required to explore the use of CFS as a surrogate for CPET testing and its use as an independent predictor for perioperative outcomes. This study supports the limited literature available.